Research Of The TMJ Function And Condylar Morphology After Operation Of Condylar Sagittal Fracture

Objective:1、To study the functional results of Condyle Sagittal fractures after surgical treatment.2、To describe the morphological changes of the post-operation condylar processes with CBCT and panoramic radiograph.3、To compare CBCT and panoramic radiograph in the diagnosis of post-operation condylars.Patients and Methods:41patients with unilateral sagittal condylar fracture who were treated surgically at the department of maxillofacial surgery, shandong provincial hospital from January2005to January2011, were included in the study. The interval between surgery and follow-up was1to6years. The patients’age was from18to57years old. and the average age was31.2years old. According to Neff’s classification.22were type A fractures.11were type B fractures and8were type M fractures.16fragments in type A fracture were fixed with steel wire.6fragments were removed because they were too small and the height of ramus were nomal.6fragments in type B fracture were fixed with steel wire.5were fixed with lag screw.8type M fractures were all fixed with steel wire, and some small fragments were removed.TMJ were evaluated with craniomandibular index developed by Fricton(1985). This index was divided into those items that reflect temporomandibular joint tenderness and functional problems, termed the Dysfunction Index (DI). and those items that reflect muscle tenderness problems, termed the Palpation Index (PI). The DI includes items related to limits in range of motion, deviation in movements, pain during movement. TMJ noise during movement, and TMJ tenderness. The PI includes items related to tenderness at distinct anatomical sites during intra-oral palpation of jaw muscles, and extra-oral palpation of jaw and neck muscles.Radiologic examination included panoraminc radiograph and CBCT. Condylar height were measured on panoramic radiograph. The morphological change of condvlar head were examined by CBCT. Results:Besides one patient with postoperative Frey’s syndrome, all other patients were satisfied with the result of the treatment. Clinical examination showed that mouth opening after intracapsular fractures of the mandibular condyle was only slightly less favorable compared with the average values found in healthy persons. In contrast, protrusion and mediotrusion of the mandible were significantly impeded. In42%of the cases, lateral deviation during mouth opening was more than2mm. Significant difference of the CMI index was found in neither the different surgical methods for the same kind of fracture type, nor the different types of fractures.Radiologic evaluation revealed a reduction in condylar height by28.3%for intracapsular fractures of the mandibular condyle types A, a reduction by17.8%for type B fractures, and a reduction24.2%for type M fractures compared with the nonfractured contralateral side. Height of all the41condylars was reduced. No significant morphological difference was found between the fractured side and the nonfractured side in the panoraminc radiograph of the same people.Conclusion:1、All the three types of condyle sagittal fracture can get the result of patient satisfaction by surgical treatment;2、Height reduction of condyle after sagittal fracture occurs in all the post-operation patients. A-type and M-type fracture are more serious than B-type fracture;3、Different degrees of absorption occurs in all the post-operation condylar. B-type fracture is not so serious as the other two types;4、There is no necessary connection between morphological changes of the condyle process after surgical treatment of Condylar sagittal fracture and the function of the temporomandibular joint;5、CBCT is much better than panoraminc radiograph in observbation of the morphological changes of the condyle.